=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861217911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIO-MEDICAL APPLICATIONS OF ARIZONA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2024
-----------------------------------------------------
Last Update Date | 11/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 S WATSON RD STE 108
-----------------------------------------------------
City | BUCKEYE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85326-3456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-824-1115
-----------------------------------------------------
Fax | 480-506-0265
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 S WATSON RD STE 108
-----------------------------------------------------
City | BUCKEYE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85326-3456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-824-1115
-----------------------------------------------------
Fax | 480-506-0265
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | BARRY BLANTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 781-699-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------